The Need for Data Integration and the Maintenance of Accurate Health and Educational Records for Children in Foster Care

Background/Purpose: Established to improve the continuity of care for children in foster care, the Health and Education Passport (HEP) is a child welfare case management tool utilized nationally to document the educational and health history of children in foster care. However, processes for creating and maintaining this document vary greatly both within and among child welfare agencies. This study aims to better understand how case managers complete and maintain accurate HEPs for foster children and how the accuracy and completeness of data impacts stakeholders.

Methods: Qualitative semi-structured focus groups were conducted with foster care case managers working at child protectives services (CPS). Focus groups were held at four different county-level agencies within one southeastern state. County-level CPS agencies were spread across regions of the state. All participants were at least 18 years of age, current employees of a public CPS agency, had at least three months experience serving foster children, and had job responsibilities that included maintaining health and educational records for children in foster care.  Participants (n=16) were a mean age of 29.94 years (median=27.5), majority female (93.75%), racially/ethnically diverse (50.00% White, 37.50% Black, 6.25% Biracial, 6.25% Hispanic), all with college degree with 25% also having a graduate degree. Inductive thematic analysis was used to develop a codebook. Each transcript was read by the qualitative team and the codebook was revised as new themes emerged. Coding was conducted in NVIVO 10.

Results: Participants described providing services to children with a range of developmental and health needs. Information about the process of maintaining records and impact on stakeholders broke into several themes: source, logistics, process variability, and impact. Case managers gather information from a wide range of sources including CPS investigators, birth parents, foster parents, educational records, medical providers, legal records, and the child. The logistics (who, when, where) of documentation include maintaining paper and electronic records, duplication, and individual strategies to streamline collection and data entry. There were extensive examples of process variability in how participants logged information, collected information, and even the extent to which participants were aware of the HEP itself. Importantly, participants indicated numerous examples of the impact of data collection on children, foster parents, and even their own experiences. For example, these impacts included children experiencing delays in school enrollment, foster parents needing to reschedule children’s appointments, and extensive efforts needed for case managers to obtain data.

Conclusions/Implications: Case managers have an extensive array of service referrals and case management commitments that need to take precedence over paperwork. However, as stated by participants, paperwork is important and incomplete paperwork impacts the well-being of all involved. Results universally support the need to provide stronger tools to CPS to enhance the collection and maintenance of health and educational records. These results will inform the development of a health and education information exchange platform for case managers that will utilize integrated data systems to maintain accurate health and educational records and streamline the paperwork process for the HEP.